title: Transgressing the ventricular wall during subthalamic deep brain stimulation surgery for Parkinson disease increases the risk of adverse neurological sequelae.
abstract: BACKGROUND
  Deep brain stimulation (DBS) at the subthalamic nucleus (STN) is an effective treatment for the motor manifestations of advanced medically refractory Parkinson disease. Because of the medial location of the target, surgical trajectories to the STN may violate the ipsilateral lateral ventricle.
  
  
  OBJECTIVE
  To determine whether violating the ventricle during STN DBS surgery is associated with postoperative confusion.
  
  
  METHODS
  A retrospective chart review of all STN implantation procedures for Parkinson disease performed by 1 surgeon between January 2005 and September 2008 was performed. Postoperative magnetic resonance imaging was performed in all cases, and each scan was reviewed for evidence of ventricular wall violation. All charts were reviewed for postoperative confusion and/or increased length of hospital stay.
  
  
  RESULTS
  A total of 145 leads were implanted in 81 patients over 102 admissions. Forty-three patients underwent contemporaneous bilateral lead implantation; 23 underwent unilateral implantation; and 18 underwent staged bilateral implantation. The cases of 8 patients were complicated by postoperative confusion and increased length of stay. Sixteen magnetic resonance imaging scans demonstrated evidence of ventricular wall violation including all 8 patients with postoperative confusion. The relative risk of having postoperative confusion after traversing the ventricle is 87 (P < .001).
  
  
  CONCLUSIONS
  Violating the ventricular system during STN DBS surgery correlated significantly with postoperative altered mental status and subsequent increased length of hospital stay. This finding may explain why cognitive complications are observed more frequently in Parkinson disease patients undergoing DBS at the STN compared with the internal globus pallidus.
authors.affiliation: Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Gologorsky
authors.forename: Sharona
authors.initials: S
authors.lastname: Ben-Haim
authors.forename: Erin L
authors.initials: EL
authors.lastname: Moshier
authors.forename: James
authors.initials: J
authors.lastname: Godbold
authors.forename: Michele
authors.initials: M
authors.lastname: Tagliati
authors.forename: Donald
authors.initials: D
authors.lastname: Weisz
authors.forename: Ron L
authors.initials: RL
authors.lastname: Alterman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003221:Confusion / Q000453:epidemiology* / Q000209:etiology; D046690:Deep Brain Stimulation / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D020547:Lateral Ventricles / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010300:Parkinson Disease / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000601:surgery*